Temporomandibular joints

Abstract

The management of temporomandibular joint (TMJ) conditions has changed dramatically since the 1970s as more advanced knowledge regarding the physiology, pathology, and evidence base has developed. One of the main barriers for this progression was the lack of specific definitions for different diagnoses associated with temporomandibular (TMD) conditions. The most recent DC/TMD guidelines have refined the different diagnoses so that clinicians can apply these criteria during the examination, diagnosis, and management of TMD patients. Historically, management strategies for articular disc displacements were aimed at surgically repositioning the articular disc or utilizing an oral appliance to advance the mandible to a point where the condyle was repositioned on the articular disc. These early management approaches often failed to produce the reduction of the pain and dysfunction that both the health-care provider and patient desired. Over time management strategies have evolved into less invasive, more patient centered, and more multidisciplinary as the multifactorial nature of TMD conditions, and specifically those related to the TMJ became evident. This chapter reviews the specific DC/TMD diagnoses and the evidence base for the utilization of different management strategies based upon a patient-centered approach. This is followed with a discussion for the implementation of various interventions such as oral appliances, physical therapy, clinical psychology, pharmacotherapy, and surgical management.